04-102327CONSTRUCT .JN PERMIT APPLICATION
CITY of ,fir PPLICATION NUMBER: - -07_ - OK
'Federal Way APPLICATION NUMBER: _ _ - _ _ _ _ _ -
PPLICATION NUMBER: - -
**The fo}Iowing is required information - Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
SITE ADDRESS, A � Avy— � ASSESSOR'S TAX/PARCEL #: Z 1 _Z j C) �9 -
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY): S e z- G C `a Ly(O
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM ,
PROJECT DESCRIPTIO}NN ((Provide detailed description): � 'if &4 v \\
LISje Wl L ��YQlitC�iAQ,It �15F'C �] �U dlr �lJlG1I Lr e�Ll�LGtiytcq
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
NAME: DAYTIME PHONE:
V \y- �S� LCl V \ f-,Cy IT T l[� b'l Jr (206 )'a—?C)
MAILING ADDRESS (S'1•REET ADDRESS; CrrY, STATE, TIP):
N``ArJ�E:
DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, IP):
EVENING PHONE:
SvU 5 ro\ �r� • S • p
-
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
1
(copy of card required)
APPLICANT' NAM€: -T:"> DAYTIME PHONE:
MNG ADDRESS (STREET ADDRESS; CITY, A ZIP): EVENING PHONE: cis
-
RELATIONSHIP TO PROJECT: ^(� pp FAX NUMBER:
❑ ARCHITECT ❑ TENANT r�'OTHER ( DESCRIBE): l ti v (0c At' Ter ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER uil PPLICANT ❑ CONTRACTOR
EXISTING USE: _ N Irn EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ C 'H
PROPOSED USE: V l VL "rC PROPOSED VALUATION FOR IMPROVEMENTS: $, 2- ��%, �S c
SPRINKLERED BUILDING? 6-YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: VUKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: d-•LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
_ l
Construction Permit Fee Calculation Sheet
*******PLEASE NOTE: ALL FEES MUST BE VERIFIED BY CITY STAFF PRIOR TO ACCEPTANCE OF PAYMENT.
CHECKS FOR INCORRECT AMOUNTS WILL NOT BE ACCEPTED!*******
Building, mechanical, and fire prevention system fees are based on the following schedule.
TABLE A
TOTAL VALUATION
FEE FACTOR
(1) $1.00 to $500.00
(1) $30.00
(2) $501.00 to $2,000.00
(2) $30.00 for the first $500.00 plus 4.00 (0-re.7ch gdtA&te1$j09.
or fraction thereof, to and including
$2,000.00
(3) $2,001.00 to $25,000.00
(3) $90.00 for the first $2,000.00 plus 98,00 for ead)+
7 0 . or fraction thereof, to and
including $25,000.00
(4) $25,001.00 to $50,000.00
(4) $504.00 for the first $25,000.00 plus
! or Fraction thereof, to and
including $50,000.00
(5) $50,001.00 to $100,000.00
(5) $829.00 for the first $50,000.00 plus SA.Otl £ar each arldirronv�l>��
� or fraction thereof, to and
including $100,000.00
(6) $100,001.00 to $500,000.00
(6) $1,279.00 for the first $100,000.00 plus 57.X1or each additional51.000.00
or fraction thereof, to and
including $500,000.00
(7) $500,001.00 to $1,000,000.00
(7) $4,079.00 for the fist $500,000.00 plus $6,Lach
gy_ p4 or fraction thereof, to and
including $1,000,000.00
(8) $1,000,001.00 and up
(8) $7,079.00 for the first $1,000,000.00 plus $4.5D for each
or fraction thereof.
Bold number is the base fee for the specified increment
rtR fired, underlined numkerrs the_Iee per�dditianal sUe[irted
increment
PLUS: Add 65 percent of the base building permit tee for plan review Tee.
Add 25 percent of the base mechanical permlt fee for mechanical plan review fee.
Add 15 percent of the base building permit fee for Fire District #39 surcharge, commercial only.
Add $4.50 for WA State Building Code Council, plus $2.00 per unit for duplex & above.
** Electrical, plumbing, and mechanical fees are calculated separately **
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number:
Estimated Permit Fee: (
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
PROPOSED VALUATION'
FEE FACTOR FROM TABLE A: Number:
Estimated Permit Fee: (
Estimated Plan Review Fee: (5
■ BUILDING
(a) Base Fee:
(b) Additional Increment Fee:
(a) Base Fee:
(b) Additional Increment Fee:
PROPOSED VALUATION: �"� 42a •.
FEE FACTOR FROM TABLE A: Number: (a) Base Fee:
(bb)) Additional Increment Fee:
Estimated Permit Fee: {6} 3
Estimated Plan Review Fee: (7) S
N PLUMBING
Base Fee Number of Fixtures
$26.00 + { X $9.00/fixture} _ _ (8) Estimated Permit Fee
Estimated Permit Fee
X .65 = (9) Estimated Plan Review Fee
Miscellaneous Fixture Charge: (10)
Sul] TOtal (Page one): Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10) = (11)